Dengue fever continues to prevail against all efforts of health-care systems: vector control programs against the mosquito vector Aedes aegypti, repellents and barrier inventions, education, and a vaccine touted with great expectations.
The Dengue vaccine has fallen short of promise: hundreds of adverse effects have been reported, a lack of efficacy to protect against the the most frequent viral serotype, and to boot, the threat that vaccine use can increase the severity of subsequent episodes There was much hue-and-cry from public health advocates and health care workers on the DOH’s “haste in the roll out of the vaccination campaign” for the Sanofi’s vaccine.
One of the things that I appreciate about President Duterte is his consistent stand against oligarchs’ abusive ways (no matter how selective), and his notion of community justice that happens not just in terms of peace and order ala war on drugs (highly arguable strategy notwithstanding), but also in terms of bringing back peace and quiet to our communities. During the campaign, I heard him talk about videoke bans in public places, and I was hopeful that things might change for us who suffer through the incessant construction noise of big urban land developers.
it was the first time i’d ever heard digong duterte speaking lengthily on anything, so i was totally unprepared for all of it. yes, the puntanginas and other cuatro letras and the libog and bathroom and bayag talk shocked me at first, pero sabay halakhak everytime. i think i forgave him very quickly for the ‘tanginas because, well, he was cursing mostly at stuff i have myself cursed at in private (except for the pope), and it was somewhat cathartic, haha.
but beyond the oral ejaculations he was talking a lot of sense, he knows, he has lived, mindanao history, and is rightfully pissed off at imperial manila and whoever made a fish out of moro hero lapulapu LOL. however, the sex talk and the going-to-confession and related stories were not as easy to forgive, napaka-for-adults-only, what if the kids are listening? my nanay was very old school.
the very next day, as i was listening to the olongapo judge’s ruling on the killing of sex worker jennifer laude by US marine scott pemberton — JUNK EDCA! — and hearing more sex talk, if on a different plane and in a different language from duterte’s — fuck, oral sex, blow, penis, vagina — the synchronocity struck me, and the thought occurred that this could be a good thing. the start of a process of desensitization to sex talk, because we NEED to talk about sex. real sex education, in the vernacular, is the only way we can stop HIV-AIDS from spreading and becoming full-blown.
The rapid rise in HIV infections nationwide, with some 21 new cases reported every day per DOH records4, has made the Philippines one of only a handful of countries at risk of a full-blown AIDS epidemic if it is unable to address the problem on time. The 646 new cases reported last February is the highest number since the Philippines’ first case in 1984, according to the DOH. The numbers in six cities — Quezon City, Manila, Caloocan, Cebu, Davao and Cagayan de Oro—already exceed the national prevalence rate of 3.5 percent4. While HIV is spread primarily through unsafe sexual contact, it can also be contracted through the sharing of dirty needles during drug use.
Increasing prevalence in key populations. National HIV prevalence remains under 0.1%, but rapidly expanding among key affected populations (KAP)2. By 2013, HIV prevalence reached 5% to 8% among males who have sex with males (MSM) in the cities of Cebu, Quezon and Manila; 53% among people who inject drugs (PWID) and 5% among female sex workers (FSW) in Cebu City1.
More are infected. The number of cases reported has shown a steep increase in the recent years – from less than 1 case a day in 2006 to 21 cases a day by March 20151. The actual cases are estimated to be at least double of those reported. The Philippine National AIDS Council (PNAC) has projected that the total number of HIV cases in the Philippines could reach 37,000 [as high as 54,000] by 20152. 12,000 of those will be needing treatment2 which could cost the Philippine Health Insurance around P360 million ($8.4 million).
Those infected are young with a median age of 27. HIV infection among 15-24 years old increased more-than ten-fold, from 44 in 2006 to 995 in 20151. The period of initiation to sex and drug use among key affected populations is as early as from 14 years old2.
Male to male transmission had significantly increased. Sex is still the main mode of transmission with, 85% of new cases were reportedly through male-to-male sex in 20151.
More local transmission. HIV cases among Overseas Filipino Workers (OFW) continue to increase (395 cases in 2013 – highest ever) despite the decrease in proportion of OFW to the total cases from 42% in 2006 to 11% in 2013 indicating that local transmission has outpaced infections reportedly contracted overseas.1
Very Low Prevention Coverage mostly below national targets of 80% since 2005; specifically 63% for establishment-based Female Sex Workers, 38% for freelance FSW, 23% for Males Who Have Sex wth Males (MSM) and 11% among people who inject drugs (PWID). Low number of Key Affected Persons (KAP) are tested for HIV (merely 14%) and zero for key affected populations under the age of 18.
High-risk practices among KAP continues. Knowledge levels (index of basic HIV knowledge including misconceptions) among Key Affected Persons was only 32%, with those aged 15 to 17 years, even lower.
basic HIV knowledge, including misconceptions, of gay and bisexuals, female sex workers, needle-using druggies, is only 32%, and even lower than that for teen-agers. sa madaling salita, kulang na kulang ang sex education. the departments of education and of health will, of course, claim that all students get sex education, but the question is, what kind?
In a recent media forum, people living with HIV (PLHIV) advocate Wanggo Gallaga said there is an immediate need for schools to include sex education modules in order to encourage those with risky sexual behaviors to practice safe sex.
“What we have to do is to educate people properly. It has to start earlier. When it comes to health, education is very shallow. Biology lang ang tinuturo sa schools e. We don’t talk about consequences of sex,” said Gallaga.
yes. it’s not enough to teach about reproductive body parts and how babies are made. kailangan din ituro ang tungkol sa libog and hormones, vaginal and anal sex, and the consequences of unprotected sex, besides unwanted pregnancies, as in sexually transmitted diseases, the worst of which is human immunodeficiency virus (HIV) infection that untreated leads to the painfully deadly Acquired Immunodeficiency Syndrome (AIDS).
most important, these teaching modules should be not only in english but also in tagalog and taglish, and gayspeak na rin, as well as in the dialects of target audiences, which should include young and old, male and female, gay and bisexual, specially the sexually active who engage in casual sex / exchange bodily fluids with different partners.
read godofredo u. stuart’s Sex Education: The Comic Failure of Language and marlon james sales’ Sex and the Missionary Position: The Grammar of Philippine Colonial Sexualities as a Locus of Translation.
sex education is key to preventing an HIV-AIDS epidemic. government agencies (DEPED and DOH) simply have to get on the job, the sooner the better. for certain the bishops will raise a howl. let them. it might even be a good sign that all they’re apoplectic about right now is the cursing at the pope, the adultery committed with two wives and two girlfriends, and the allegation of sexual abuse by jesuits. i haven’t heard anyone decrying the bayag and libog talk. maybe they can’t find the words. while we have all the words we need.
I thought the controversy on the ActRx Triact anti-dengue drug was going to die a quiet death—consigned to inevitable oblivion by the strong arm of politics that threatened many close to the heart of the research, nitpicked every which way, vilified as crap, with a media ensemble so eager to chorus their tsutsuwariwaps, amens and hallelujahs for the rantings of the powers that be.
But, perhaps, the controversy is far from dead. There has been a flurry of emails from the other side of the controversy—taking Garin, Claudio, and Leachon to task.
But now, a new voice from the anti-Ona trenches—Dr. Francisco Tranquilino, a regent of the Philippine College of Physicians Board and Assistant to the dean and college secretary of the UP College of Medicine. He sings the familiar line: the ActRx Triact dengue study was “technically and ethically fatally flawed.”
Dr Tranquilino draws on the Declaration of Helsinki-Ethical Principles for Medical Research Involving Human Subjects. He criticizes the inclusion of children in the Triact study as a “vulnerable” group. But how can you exclude children in a drug study for a disease where the children population is most vulnerable, where the majority of deaths happen in the same population. Also, nowhere in the Helsinki Declaration is it stated that children should be excluded in all studies. In fact, article 20 states: Medical research with a vulnerable group is only justified if the research is responsive to the health needs or priorities of this group and the research cannot be carried out in a non-vulnerable group. In addition, this group should stand to benefit from the knowledge, practices or interventions that result from the research. The article, in essence, supports the study of the drug in this vulnerable group of patients.
And again, to belabor what has been said so many times, artemisinin has been extensively studied and used in thousands of children and has proven to have an excellent safety profile.
Not done with bully pulpit pronouncements, Dr. Tranquilino draws from history and says: “Like the Nuremberg Trial, we might need out own Manila Trial” —referring to a series of trials for the prosecution of prominent members of the political, military, and economic leadership of Nazi Germany in the 1940s. Is he insinuating an analogy with the “Doctors’ Trial” brought about by Nazi human experimentations that led to the development of the Nuremberg Code of medical ethics?
A Manila Trial akin to the Nuremberg Trial? Are the doctors being accused of crimes against humanity? Is their research work being compared to Nazi human experimentation? That is a grievous, malicious, odious and defamatory insinuation—an insult to the Philippine medical research community. It demands an apology.
It also calls upon the community of physicians—researchers and clinicians alike—to show visible and audible umbrage. Till now, there have been only emails expressing quiet dissent, decrying the dirty and brutal politics that reigned in the Ona ouster and termination of the Actrx Triact anti-dengue drug study. To continue with silence is to risk consigning future medical research to the control of politics and politicians—to its inevitable demise or awful compromise.
And to Dr. Anthony Leachon, president of the Philippine College of Physicians: Do you agree with this position and insinuation by Dr. Tranquilino? And, lastly, let me rephrase your quote : “The interest of patients should take precedence over the interest of science.” I posit: The interest of patients should take over the interest of politics.